What happens when there is disagreement between an MD and a patient or substitute-decision maker (SDM) about code status? Is it ethical (or legal) for a physician to unilaterally make a patient “DNR”? Check out this short thread 🧵 and our new publication in CJA - Canadian Journal of Anesthesia below

Finally published 🔥EPIC-SR🔥 The time to sustained alleviation of all signs and symptoms of Covid-19 did not differ significantly between participants who received Paxlovid nirmatrelvir–ritonavir and those who received placebo #IDXposts nejm.org/doi/full/10.10…

Unsurprisingly the EPIC-SR trial of paxlovid failed to show significant benefit in low risk people with COVID. Enrollment stopped in July 2022. There was no pre-print. My question: Why did it take *years* to publish this? Dragging their feet on publishing made Pfizer billions.

There is definitely a need for a stable supply of plasma but does this aggressive marketing by Grifols Canada (Grifols) - which runs Canada's pay-for-plasma clinics - take it too far? "Gold" if you donate 2x/wk for 5 straight weeks! Raises real concerns about exploitation. #onpoli

By age 35, every critical care clinician should have six PowerPoint presentations about basic clinical topics with no animations, a set of scrubs stolen from a minimum of three hospitals, and an iPhone video of a SonoSite screen showing cardiac tamponade. #medtwitter

3/ 🎶 History has its [lungs] on you 🎶 Take a look at the table below to put key trials into perspective on how we got to this point!

Is anaerobic coverage necessary for aspiration pneumonia with metronidazole or Augmentin? NEJM JWatch reports from a large retro study with N ~ 4000 Findings show no added mortality benefit but an increased risk of CDI journal.chestnet.org/article/S0012-… #IDTwitter #IDXposts

I am disgusted and not a shred surprised. We have lost our way. Mr. Meunier stuck on an ER stretcher for 4 days with consequent bone and muscle exposed said "I don't want to be a burden". He was granted death through medical assistance in dying. cbc.ca/news/canada/mo…

In 1 week 4 cyclists contacted us after suffering injuries from doorings. 2 needed surgery. Clearly motorists are not expecting (wrongfully) to see the Spring influx of cyclists on our roads. Read our dooring guide to stay safe & protect yourself: thebikinglawyer.ca/post/doorings-…

When do we need to cover MRSA / Pseudomonas? ✅If isolated previously. ✅If recent admission and IV antibiotics AND severe PNA. That's the list. If you trained before 2019, forget the HCAP stuff you used to know. #SHEASpring2024 11/

Duration of therapy? 5 days. (As long as clinically stable by 48-72 hours). RCT proving the guideline rec highlighted below. #SHEASpring2024 12/

While nearing the end of the incredible Critical Care US fellowship run by Robert Arntfield, I was inspired to create my first ever screencast, demonstrating the power of echo hemodynamics. Please give it a watch: youtube.com/watch?v=uHPG2X… #POCUS #hemodynamics #CardioTwitter #echofirst

REDUCE-AMI trial: Among patients with an acute myocardial infarction and preserved ejection fraction, long-term treatment with beta-blockers did not lead to a lower risk of death or myocardial infarction than no beta-blocker treatment. Full trial results: nej.md/4akVhRx

I've seen miles of train graffiti but I've never seen anything like this..

Currently, 2.3M Ontarians are without a family doctor and 1 in 4 are projected to be without one by 2026. System-wide challenges including compensation that hasn’t kept pace with inflation and the rising cost of running a practice are driving family docs from the profession.

How is that >98% of Danes have a GP? Part of the answer lies in their approach to training physicians. Here's a summary of some of what I've learned on my trip to Denmark 🇩🇰 🧵 (the photo here is a wall of some of the 170+ residents trained at the practice I visited)

- Spends a billion dollars of public money for no real purpose other than to buy a few votes. - Creates the largest cabinet in the Province’s history. - Takes the next 19 weeks off. Getting it done for the people.